Senate Republicans released version 2.0 of their healthcare bill yesterday. Overall, the bill closely hews to the last version of its repeal-and-replace "Better Care Reconciliation Act of 2017" and contains very few provisions that will directly impact the employer market.
Key changes affecting the employer markets:
Retains the ACA Medicare and net investment taxes for high income individuals, both of which would have been eliminated under both the House bill and the prior Senate bill
HDHPs must not include coverage for abortion to qualify for HSA contributions
Adds new provision allowing HSA funds to be used to purchase health insurance (subject to certain restrictions)
Small Employer HRAs: deletes requirement that HRA paid-for coverage be "affordable"
Small Business Health Plans: these provisions first included in the prior Senate bill are retained but have been modified somewhat. It does not appear that any of the modifications are significant
HSA "qualified medical expenses" expanded to now include medical expenses for dependents up to age 26
Other changes of note:
Retains the excise tax on health insurance providers who pay executives more than $500k per year (which would have been eliminated under both the House bill and the prior Senate bill)
Allows health insurers to offer catastrophic coverage in any market without age restriction provided that they offer at least one full coverage option in that market
Adds $70 billion in new funding for insurers insuring high risk individuals and who agree to offer coverage in under-served markets
Compared to the last version on which we reported, the bill does have a continuous coverage requirement equaling a mandatory six-month waiting period for coverage if an individual can't demonstrate 12 months of continuous coverage; notably, places obligation on issuers to certify/report months of "creditable coverage" and waiting periods (this differs from the House bill, which would put reporting obligation on employers on W-2s)
Source: The Council of Insurance Agents & Brokers and their legal team Steptoe & Johnson.
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